Living well with osteoporosis

In simple terms it means porous bones. Bones, which are breaking down and rebuilt throughout your life, are less efficient at rebuilding as you get older so they become weaker and lose density.

Are you at risk?

If you are female and over age 45 then probably yes. If you meet any of the following factors then you will be at higher risk:

A parent had osteoporosis, was hunched, had fractures or shrank considerably with age

You are of Caucasian or Asian descent

You’ve ever had an eating disorder, have been extremely slender or are under weight

You’ve had irregular periods

You smoke (or have ever smoked) or drink alcohol above national guide lines

You’ve been on long term medication ( steroid/laxative/thyroid/antacid)

You don’t exercise or over exercise

You have digestive problems or are coeliac, or have Crohn’s disease.

You’ve never had children

You had an early menopause

You are getting shorter or have already suffered a broken bone

Testing and drug therapy for Osteoporosis.

If you are concerned about osteoporosis then you may have already consulted your GP, had tests and been given medication. Research in this area is ongoing so it is definitely worth seeking your GP’s advice as to the medical treatment available.

I am not giving advice in this area, but aim to help you manage your condition, or delay the onset through food and exercise.

Theory’s about the body’s acid/alkaline balance.

Scientists and experts do not agree on what we should eat to reduce our risk of OP. This makes it extremely difficult for the general public to make an informed decision as to the best diet to follow. There seems to be two main views on limiting the effect of OP.

One is to follow an alkaline diet, the other to follow a balanced diet including all food groups.

Key points from those recommending an alkaline diet:

·The acid/alkaline balance of our body plays a large part in much of the media coverage of OP.

·It is claimed that calcium neutralises the body’s ph so it uses up reserves to counter the acidity caused by eating acidic food.

·If your diet is acid (more of this later) then your bones will give up calcium to balance the ph.

·With age our bodies do not excrete acid as efficiently so our bodies become more acidic.

·Limit dairy as the acid level can cause more loss of calcium than gain

·Proteins with high acidic levels include red meat, chicken, eggs, cheese, most nuts

·68g of protein daily is much better than consuming over 95g (Tracking your food intake over a few days and using a nutrition calculator such as MyFitnessPal will give you a good idea as to where your protein intake level is)

This advice is at odds with the recommendations of the UK National OP Society for a balanced diet with all food groups. They do not reference the body’s acid/alkaline balance at all. I have not, so far, been able to find any scientific basis for this balance.

As a sport nutritionist I follow the latest research and have a particular interest in eating for good health. In my opinion, a healthy eating plan will ensure that your weight is stable and by adding in a few tweaks for specific issues we can address health issues without ever following ‘a diet’. Find an eating pattern which suits you and which you can follow for life, then you can make changes permanent and, as a result, you will gain the most benefit.

My advice for managing Osteoporosis

Having looked at much material and research I think that a balanced approach is required. Doctors know much more about the science behind our bodies so rely on them for medication. They may not be as knowledgeable about diet and exercise so that is where you need to make your own decisions.

My key dietary points:

·Avoid fizzy drinks, processed food, artificial sweeteners and stress

·Cut down on caffeine, sugar, salt and alcohol

·Be aware that spinach and rhubarb contain oxalic acid which prevents absorption of calcium. I’m not sure how much evidence there is to support this is but there are so many other sources of calcium it seems sensible not to rely on these.

·Increase your intake of green leafy vegetables (list below) they are seen in all the ‘good lists’ for calcium and other vitamins

Exercising with arthritis?

The first thing to remember is that ‘Exercise is beneficial for people with arthritis’. Arthritis is a very general term which covers a multitude of conditions which affect joints and is frequently (but not always) linked to the body’s aging process.

If you have arthritis follow these simple guidelines to get the most benefit from your exercise:

Make sure your warmup is slow and gentle warm up with movement to mobilise your joints encouraging the release of synovial fluid to lubricate the whole joint more effectively. It’s a bit like warming oil in a pan so it coats the whole pan surface.

Choose low impact activities to reduce the stress placed on the joint. Pilates, yoga, walking and swimming are all good.

Include strength training as studies have suggested it can decrease pain. It also works to build bone density which encourages healthy joints. Simple exercises standing up can help build strength so don’t choose classes which are all mat based.

Try to maintain the range of movement and flexibility of a joint. You may not become more flexible but should be able to maintain the movement range that you currently have. (Without regular exercise you will gradually have less range of movement.)

Don’t exercise if you have rheumatoid arthritis and your joints feel warm and swollen. This is an indication of flare up and exercise at this time could worsen your condition.

How important is balance to your overall health and well being?

Many clients I see have very poor balance skills when they first attend The Studio. This usually improves hugely within a few weeks. I am frequently asked why it is that our balance is so bad, and, why it is important to improve it.

Firstly, why is our balance poor?Balance is a motor skill which we acquire in childhood. It requires the use of large muscles groups and although this skill remains with us throughout our lives it deteriorates with age. At any stage of your life it is possible to improve your balance skills with training.The ageing process causes muscle weakness which will affect the body's ability to recover from a trip on an uneven surface. With age often comes inner ear misbalance causing dizziness or blood pressure issues which can cause light-headedness. Also failing eyesight means you may mis-judge uneven surfaces, or distances from objects. All of these situations can easily lead to falls.

How big a problem is this?It is estimated that 30% of the over 65's fall every year, and more than half of the over 75's living in nursing homes or care facilities are unable to live independently because of falling.Women suffer from bone thinning (osteoporosis) and this increases the risk of hip fractures if they suffer a fall. Almost 50% of hip fractures are seen in people who had no mobility problems prior to their fall, however only 50% recovered to their previous level of mobility (NICE 2012)

How does this affect you?

Every time you walk you put all of your weight on your front foot as you lift the back foot up to swing it through. If you step on an uneven surface, ice or simply misjudge the height of a kerb you will need to be able to balance on one leg for that little bit longer than usual to avoid falling. This is particularly true when walking down steps.

When you reach up to a high shelf you probably balance on one leg to gain extra height.

When you get out on the car you will place one foot down and put your weight through that leg as you push up to standing. The added twist provides more challenge to the balance and it is easy to strain your back if your muscle structure doesn't support you too.

Things to remember

Balance can be improved with practise both in a controlled environment such as with an exercise therapist and at home.

Improved core strength gives better balance.

A fall can signal the end of independent living, changing your life completely.

Is there an age when exercise becomes bad for you, risky or inappropriate?

At what age does it become bad, too risky or inappropriate for you to exercise?

In my opinion the answer is there is no age beyond which exercise should not be attempted!I may be biased having worked in the world of exercise all my life and coming from an active family but my opinion is backed up by recent research and national recommendations.

The current government recommendation for those aged over 65, is1. To be active daily2. To accumulate 150mins weekly of ‘moderate intensity activity’ in bouts of at least 10mins at a time3. To exercise twice weekly for strength, flexibility, balance and co-ordination4. Minimise the amount of sedentary time. (sitting)5. Some activity is better than none, and more provides greater health benefits

This might sound onerous, but in reality it can be achieved very easily.

Let’s look into these guidelines a bit deeper to see how easy it is to meet them and what the benefits are.

First we can consider why should we exercise at all?• All muscle wastes away if it is not used: the motto use it or lose it really is true.• Skills such as balance and co-ordination deteriorate with age. However they can be maintained and even improved with regular practise. This deterioration is the main case of older people falling so easily, so controlled exercise will reduce your risk of falling.• Bone density also deteriorates with age meaning falls are more likely to result in fractures. Controlled exercise will improve bone density hence reducing the risk of fractures.• Posture can deteriorate as we age for all sorts of reasons, most of which are correctable by specific targeted exercise: don’t become a stooping person!• Your cardio-vascular system ages with you. We get higher blood pressure, less efficient blood flow around the body and much reduced oxygen uptake by the body, leaving us feeling less like exercise, when in fact we need more! See point 1.• If you are suffering from arthritis, exercise is known to be beneficial, reduce levels of pain and improve mobility.

Second, what is moderate intensity activity (point 2 of the recommendations)?Activity, here, can be defined as any movement that increases your heart rate from its normal resting rate. The measure of moderate intensity is different for every individual. It is not advisable to use any generic figures for this, the best approach would be to ask any appropriately qualified instructor.

What activities could count as moderate intensity?Walking is brilliant provided it is on a regular basis and is appropriately vigorous. We can check whether you are being vigorous enough by testing your activity level in a SELECT class. If you walk your dog daily it is quite possible that you already meet the guidelines for cardiovascular exercise.

Interestingly, golf is found to be of limited benefit. It is not aerobic, it promotes misbalanced strength and flexibility in the body and research shows no bone density improvement. This would not count.

Gardening is also classed as non-beneficial. The bending, reaching and kneeling all puts stress on the body rather than strengthening it.

Swimming is similar to walking in that it can be great for cardio if it is done regularly and with appropriate vigour. However it doesn’t improve bone density or balance. And if you suffer any joint issues, breaststroke should be avoided.

Other exercises to consider that can be beneficial are, cycling, rowing or cross-training in the gym.

So what exercise is available to address point 3 of the recommendations?Generally these exercises are specific routines that are performed in classes, in the gym, in a swimming pool or at home. The important point here is to ask an appropriately qualified instructor for guidance on what would be the most beneficial forms for you, and also to teach you how to perform the movements without them being detrimental to you.

Pilates is probably the most suitable form of exercise as it is controlled and specific in its aims. It doesn’t encourage excessive movement, and primarily uses the body’s own weight for resistance. This means it is particularly accessible even for people to do at home.

I have developed a specific variant of Pilates designed to be particularly beneficial for people with injuries, aches and pains, bad backs and posture difficulties. In “I Move Freely” Pilates classes I use biomechanic exercises to gain the maximum benefit in loosening stiff joints, backcare exercises to strengthen yet protect the spine as well as strengthening exercises for the muscles which give support to our skeletal structure. Posture is addressed with work to open the shoulder girdle, thus preventing the shoulder rounding which can easily lead to ‘hunching’. Also, I avoid some traditional Pilates exercises (e.g. roll downs, the 100 or double leg lifts) which put pressure on the lower back, neck and pelvic muscles. Provided you exercise correctly and regularly in class and continue to use the correct muscle engagements throughout the week when doing normal everyday activities you will be gaining strength and stability.

What if you don’t feel able to take part in a class nor want to go to the gym?SELECT is a small group class (max 4 people) I run specifically to cater for you. Because the attendees are very limited the exercises can be completely tailored to your individual needs. For example, if you cannot get down to the floor, or you cannot stand for any period, we can provide chair based exercise, or we have exercise couches. If you find it uncomfortable on normal exercise mats we can provide memory foam mats which protect any protruding, or painful parts from the hard floor.As another example, If you have specific recommendations from your GP or physio, we are experienced at working with your practitioner to make sure the exercises are appropriate to your needs.SELECT allows me to shape the class to each individual whatever their requirements.Consequently, SELECT makes getting started easy, it is friendly, focussed to your needs, will address concerns you may have about your body as it ages and work towards keeping you independent and active – fit for life for all of your life.

If you are unsure in any way about attending a class or what exercise is suitable for you, please arrange to pop in for an informal chat and see how easy it is to incorporate exercise into your life.

Osteoporosis - A simple guide

What is it?Osteoporosis is a weakening of bones which can lead to an increased risk of fracture

Who is at risk?You are at risk if you: are menopausal, have a family history, have broken a bone, are of slim build, if you endurance train, do not eat properly, smoke, are a heavy drinker, are underweight, are inactive.

Signs to look out forOsteoporosis itself has no symptoms but a fall is more likely to result in a fracture.As it progresses you will lose height, and develop a hunch as your thoracic spine curves.

What can you do about it?Undertake specific exercise to strengthen muscle and improve bone strengthPractice falls prevention, train in balanceMake your diet healthy with moderate alcohol intakeDo not smoke.

Current guidelines for test results for the T score:Normal: -1 to 1Starting to weaken (normal for age): -1 to -2.5Osteoporosis: below -2.5